Pitfalls of Incomplete Myelography with Thoracic Spinal Lesions

ABSTRACT:This paper describes four patients with thoracic spinal lesions in whom the initial clinical presentation was highlighted by complaints in the lower back and lower extremities, in the absence of thoracic spinal or radicular symptoms. Initial myelography, confined to the lumbar region, failed to reveal a cause for the patients’ symptoms. Subsequently, diagnostic consideration of a thoracic spinal lesion prompted repeat myelography of the thoracic region which demonstrated a relevant lesion in each case. It is important to visualize the thoracic cord when myelography is performed for the investigation of pain or neurological symptoms in the lower back or lower extremities.

Download Full-text

Concurrent Thoracic Spinal Intradural Extramedullary Epidermoid and Neurenteric Cyst in a Spinal Dysraphism Child

Pediatric Neurosurgery ◽

10.1159/000511091 ◽

2021 ◽

pp. 1-7

Author(s):

Rajeev Sharma ◽

Swati Mahajan ◽

Minakshi Bhardwaj ◽

Laxmi Naraian Gupta ◽

Deepak Gupta

Keyword(s):

Surgical Planning ◽

English Literature ◽

Spinal Dysraphism ◽

Neurenteric Cyst ◽

Germ Layers ◽

Case Presentation ◽

Spinal Lesions ◽

Congenital Origin ◽

Thoracic Spinal ◽

Intradural Extramedullary

Introduction: Intraspinal epidermoid cysts are congenital or acquired in origin; whereas intraspinal neurenteric cysts (NECs) are of congenital origin. Their individual association with spinal dysraphism and vertebral segmentation anomalies is very well known. Case presentation: We hereby report a case of concurrent intradural extramedullary epidermoid and NEC at adjacent vertebral levels in a spinal dysraphism child, not reported in English Literature till now. Conclusion: Multiple spinal lesions related to any/all of the 3 germ layers can coexist at same or adjacent vertebral levels in the same patient and surgical planning shown to be done accordingly.

Download Full-text

Transdural herniation of the thoracic spinal cord: untethering via a posterolateral transpedicular approach

Journal of Neurosurgery Spine ◽

10.3171/spi.2004.1.2.0223 ◽

2004 ◽

Vol 1 (2) ◽

pp. 223-227 ◽

Cited By ~ 20

Author(s):

Ryder Gwinn ◽

Fraser Henderson

Keyword(s):

Spinal Cord ◽

Posterior Approach ◽

Thoracic Spinal Cord ◽

Dural Repair ◽

Content Type ◽

Transpedicular Approach ◽

Thoracic Spinal ◽

Novel Approach ◽

Spinal Cord Herniation ◽

Thoracic Cord

✓ Anterior spinal cord herniation is a well-documented condition in which the thoracic cord becomes tethered within a defect in the anterior dura mater. Typical procedures have involved a posterior approach with direct manipulation of the thoracic cord to expose and blindly release its point of tethering. The authors report three cases in which a novel approach for the treatment of anterior thoracic cord herniation was performed, cord manipulation and traction are minimized, and direct dural repair of the defect is performed.

Download Full-text

Dyspnoea and Thoracic Spinal Deformation in Rats after Oral Prizidilol (SK&F 92657-A2)

Human Toxicology ◽

10.1177/096032718600500306 ◽

1986 ◽

Vol 5 (3) ◽

pp. 183-187 ◽

Cited By ~ 6

Author(s):

T. J. Sutton ◽

A. J. Darby ◽

P. Johnson ◽

G. B. Leslie ◽

T. F. Walker

Keyword(s):

Cardiac Hypertrophy ◽

Drug Effects ◽

Male Rats ◽

Thoracic Cavity ◽

Control Groups ◽

Thoracic Spinal ◽

Spinal Lesion ◽

Second Year ◽

And Control ◽

Body Damage

Prizidilol (SK&F 92657-A2), an anti-hypertensive agent, has undergone a range of prescribed toxicity studies required for the investigation of possible adverse drug effects. During the second year of the 2-year rat oral study, a variety of symptoms were exhibited by males receiving 1600 mg of the compound day–1kg–1 by gavage. These animals became lethargic, slouched and developed dyspnoea which became progressively more severe during the course of the study. Necropsy of the affected rats revealed severely haemorrhagic lungs, cardiac hypertrophy and lordosis of the spine into the thoracic cavity. At the 2-year terminal kill, a proportion of the male rats receiving 100 and 400 mg of prizidilol day–1kg–1 were identified with similar but less severe spinal deformation. No female was found with spinal changes but all the rats receiving prizidilol showed haemorrhagic lungs and enlarged hearts. The lordosis of the affected males was always confined to the thoracic spine and this, along with the cardiac hypertrophy, presumably led to marked reduction in the volume of the thoracic cavity, inducing the dyspnoea. Thoracic vertebral body damage, possibly a precursor to the spinal deformities, was found in male rats from both drug-treated and control groups. The nature of the spinal lesion is at present under investigation.

Download Full-text

Spinal Intradural, Extramedullary Ependymoma with Astrocytoma Component: A Case Report and Review of the Literature

Case Reports in Pathology ◽

10.1155/2016/3534791 ◽

2016 ◽

Vol 2016 ◽

pp. 1-5 ◽

Cited By ~ 2

Author(s):

Gene M. Weinstein ◽

Knarik Arkun ◽

James Kryzanski ◽

Michael Lanfranchi ◽

Gaurav K. Gupta ◽

...

Keyword(s):

Back Pain ◽

Case Report ◽

Lower Back Pain ◽

Low Grade ◽

Review Of The Literature ◽

Pathologic Evaluation ◽

Lower Back ◽

Spinal Lesions ◽

First Case ◽

Intradural Extramedullary

Ependymomas are common spinal lesions, with the vast majority arising in an intramedullary location. Several cases have been described in the literature of ependymomas in an intradural, extramedullary location. The authors present a case of a 56-year-old female who presented with several weeks of lower back pain and weakness. MRI revealed an intradural, extramedullary enhancing mass at L1-L2. The mass was successfully resected surgically. Pathologic evaluation revealed a low grade glioma with components of both ependymoma and pilocytic astrocytoma with MUTYH G382D mutation. Extramedullary ependymomas are very rare tumors. To the authors’ knowledge, this is the first case of ependymoma/astrocytoma collision tumors described in an extramedullary location.

Download Full-text

Coordinating relationships between the muscles of the lower back and lower extremities in patients with non-neurodystrophic form of lumboischialgia

Kazan medical journal ◽

10.17816/kazmj62197 ◽

1985 ◽

Vol 66 (6) ◽

pp. 437-440

Author(s):

O. V. Vasilevskaya

Keyword(s):

Significant Role ◽

Lower Extremities ◽

Lower Back ◽

Biomechanical Factors

Biomechanical factors play a significant role in the formation of spinal osteochondrosis syndromes.

Download Full-text

Work-Related Musculoskeletal Symptoms among Loggers in the Ark-La-Tex Region

Journal of Agromedicine ◽

10.1080/1059924x.2019.1567423 ◽

2019 ◽

Vol 24 (2) ◽

pp. 167-176

Author(s):

Rodriguez ◽

Casanova ◽

Levin ◽

Gimeno Ruiz de Porras ◽

Douphrate

Keyword(s):

Risk Factors ◽

Environmental Conditions ◽

Lower Extremities ◽

Musculoskeletal Symptoms ◽

Work Related ◽

Personal Risk ◽

Industrial Sectors ◽

Lower Back ◽

Related Risk ◽

Personal Risk Factors

Background: The U.S. logging sector is among the most dangerous industrial sectors, with high fatality and non-fatal injury rates. Limited research has addressed work-related musculoskeletal disorders among logging machine operators (LMOs). The purpose of this study was to estimate the 12-month prevalence of musculoskeletal symptoms and the associated work-related risk factors among LMOs in the Arkansas, Louisiana, and Texas (Ark-La-Tex) logging region.Methods: A self-administered 93-item questionnaire with six different sections: (1) demographics, (2) lifestyle and medical background, (3) work experience, (4) job training, (5) occupational heat-related stress, and (6) occupational injuries and MSS was administered to LMOs (n = 88) using Qualtrics Mobile Survey Software®. Poisson regression models were used to estimate crude prevalence ratios (PR), adjusted PR [aPR], and corresponding 95% confidence intervals (95% CI).Results: Regarding organizational, ergonomic, and handling equipment occupational factors and 12-month MSS prevalence, the adjusted model controlled for age, BMI, smoking status, and drinking status. For organizational, the most problematic factors for the lower back were performing a task over and over (63.2%) and working very fast, for short periods (60.0%). For ergonomics, the most problematic factor for the lower extremities was awkward or cramped conditions (58.1%) and for the lower back was bending/twisting back awkward (55.9%). Last, for handling equipment, the most problematic for both the lower back and lower extremities was handling or grasping small objects (57.1%).Conclusion: Our findings revealed associations between work-related MSS and specific job factors (e.g., organizational, ergonomic, handling equipment, etc.), extreme environmental conditions or environmental, and personal risk factors. In particular, study findings suggest lower back and lower extremities MSS are associated with the a majority of job-related risk factors, lower extremities with extreme environmental conditions, and neck and upper back with personal risk factors.

Download Full-text

Primary lumbar paraganglioma: A single-centre UK experience over 21 years

Neuro-Oncology ◽

10.1093/neuonc/noz167.065 ◽

2019 ◽

Vol 21 (Supplement_4) ◽

pp. iv15-iv15

Author(s):

Francesco Fiorini ◽

José Pedro Lavrador ◽

Francesco Vergani ◽

Ranjeev Bhangoo ◽

Richard Gullan ◽

...

Keyword(s):

Back Pain ◽

Adrenal Glands ◽

Cauda Equina ◽

Case Series ◽

Lumbar Region ◽

Single Centre ◽

Histological Features ◽

Surgical Disease ◽

Lower Back ◽

Histological Data

Abstract Objectives Paragangliomas are rare neuro-endocrine neoplasms which may occur at multiple anatomical sites, typically the adrenal glands. In the CNS, they can affect the head and neck, and more rarely the lumbar region. Primary lumbar paragangliomas are prominently vascularised lesions which can present variably and pose both diagnostic and surgical challenges. Methods We identified and analysed all cases of lumbar paraganglioma confirmed both surgically and histologically, treated at our regional neurosurgical centre. We collected retrospective clinical, radiological, surgical and histological data. Results We treated 25 patients with confirmed paraganglioma between 1997–2018. This included 19 primary tumours, of which 13 cases of primary lumbar paraganglioma (8 males (61.5%); mean age 51.3 years, range 33.2 – 68.9). Patients presented most frequently with a recent worsening of long-standing lower back pain and sciatica. 7 patients were admitted as emergency cases, including 3 with cauda equina syndrome. The average Ki67 mitotic index was 5.7% (range 1 – 10%). Conclusion We present one of the largest case series of primary lumbar paragangliomas to date to the best of our knowledge. Defining these clinical, radiological, surgical and histological features may be of assistance in recognising and managing this surgical disease.

Download Full-text

Mechanically stimulating the lumbar region inhibits locomotor-like activity and increases the gain of cutaneous reflexes from the paws in spinal cats

Journal of Neurophysiology ◽

10.1152/jn.00747.2019 ◽

2020 ◽

Vol 123 (3) ◽

pp. 1026-1041

Author(s):

Angèle N. Merlet ◽

Jonathan Harnie ◽

Madalina Macovei ◽

Adam Doelman ◽

Nathaly Gaudreault ◽

...

Keyword(s):

Nerve Stimulation ◽

Inhibitory Effect ◽

Short Latency ◽

Lumbar Region ◽

Cutaneous Reflexes ◽

Cutaneous Reflex ◽

Thoracic Spinal ◽

Weight Support ◽

Reflex Gain ◽

Excitatory Responses

Mechanically stimulating the dorsal lumbar region inhibits locomotion and reduces weight support during standing in rabbits and cats. However, how this inhibitory effect from the lumbar skin is mediated is poorly understood. Here we evaluated the effect of mechanically stimulating (vibration or pinch) the dorsal lumbar region on short-latency (8- to 13-ms onset) cutaneous reflex responses, evoked by electrically stimulating the superficial peroneal or distal tibial nerves, in seven adult cats with a low thoracic spinal transection (spinal cats). Cutaneous reflexes were evoked before, during, and after mechanical stimulation of the dorsal lumbar region. We found that mechanically stimulating the lumbar region by vibration or manual pinch abolished alternating bursts of activity between flexors and extensors initiated by nerve stimulation. The activity of extensor muscles was abolished bilaterally, whereas the activity of some ipsilateral flexor muscles was sustained during vibration/pinch. Mechanically stimulating the lumbar region increased ipsilateral and contralateral short-latency excitatory responses evoked by cutaneous inputs, a phenomenon that was generalized to muscles crossing different joints and located in different limbs. Our results indicate that the inhibitory effect on locomotion and weight support is not mediated by reducing cutaneous reflex gain and instead points to an inhibition of central pattern-generating circuitry, particularly the extensor component. The results provide greater insight into interactions between different types of somatosensory inputs within spinal motor circuits. NEW & NOTEWORTHY Vibration or pinch of the lumbar region in spinal-transected cats abolished alternating bursts of activity between flexors and extensors initiated by nerve stimulation. Mechanically stimulating the lumbar region increased ipsilateral and contralateral short-latency excitatory responses evoked by cutaneous inputs in hindlimb muscles. Sensory inputs from mechanoreceptors of the lumbar region do not mediate their inhibitory effect on locomotion and weight support by reducing the gain of short-latency excitatory cutaneous reflexes from the foot.

Download Full-text